Understanding the prehospital physician controversy
by Hans van Schuppen. Last modified: 01/10/14van Schuppen H1, Bierens J. Understanding the prehospital physician controversy. Step 1: comparing competencies of ambulance nurses and prehospital physicians. Eur J Emerg Med. 2011 Dec;18(6):322-7. PMID: 21460731.
In many European countries prehospital care by emergency medical services (EMS) is supplemented by physician-staffed services. There is ongoing controversy on the benefits of a prehospital physician. Possible advantages are additional competencies of the physician. Similarities and differences in competencies of EMS providers and physicians have however never been studied. This study aims to compare competencies of ambulance nurses and helicopter EMS physicians in the Netherlands to gain better insight into the controversy of the prehospital physician.
In this descriptive study, a quantitative inventory was made of the diagnostic, therapeutic, and clinical judgment competencies of the ambulance nurse and physician, based on analysis of protocols, registration, equipment, and personal interviews.
We identified 438 mutual competencies of the ambulance nurse and physician and 62 physician-specific competencies. The ambulance nurse masters 278 diagnostic, 131 therapeutic, and 29 clinical judgment competencies. The physician masters 285 diagnostic, 175 therapeutic, and 40 clinical judgment competencies. Seventy-one percent of the physician-specific competencies are therapeutic and related to advanced life support.
The ambulance nurse and physician have various mutual competencies. In addition, the physician can provide specific competencies on the scene. Knowing the exact overlap and differences in competencies is the first step to understand the prehospital physician controversy. Our results can be used as a tool for the next step in research on prehospital care by EMS providers and physicians and to improve prehospital care.
van Schuppen H1, Bierens J. Understanding the prehospital physician controversy. Step 2: analysis of on-scene treatment by ambulance nurses and helicopter emergency medical service physicians. Eur J Emerg Med. 2014 Sep 12. PMID: 25222422.
In our previous study, we identified the similarities and differences in competencies of ambulance nurses and helicopter emergency medical service (HEMS) physicians in the Netherlands. This ensuing study aims to quantify the frequency with which the additional therapeutic competencies of the HEMS physician are utilized and to determine whether this is the main reason for usefulness as perceived by ambulance nurses and HEMS physicians.
Materials & Methods
A prospective observational study was carried out over a 2-month period, with one HEMS station covering six ambulance regions. Provider registration was recorded, supplemented by interviews of ambulance nurses and HEMS physicians. Competencies were categorized depending on whether the competency was specific for the nurse or physician, mutual or mutual with a qualitative difference.
A total of 225 HEMS dispatches resulted in 117 cases with HEMS on-scene in the study region and 78 patients were included. In 35 (45%) patients, the HEMS physician provided additional treatment: in 19 (24%) patients, a physician-specific therapeutic competency, in nine (12%) patients, a mutual competency with a qualitative difference and in seven (9%) patients, both categories. The presence of the HEMS physician was considered more useful by both ambulance nurses (89 vs. 60%) and HEMS physicians (97 vs. 81%) when additional treatment was provided by the HEMS physician.
HEMS physicians provide additional treatment in 45% of patients. The additional treatment increases the perceived usefulness of the HEMS physician. The presence of the HEMS physician was also considered useful when the physician did not provide any additional treatment, possibly because of diagnostic competence and clinical decision-makingThe following two tabs change content below.
Hans van SchuppenHans is a passionate anesthesiologist and fellow in Intensive Care at the University Medical Center Utrecht. Areas of interest are resuscitation, prehospital care, airway management, education and human factors. Next to his fellowship, he is an EMS Medical Director. He enjoys giving courses in Advanced Life Support (ERC), Airway Management, and lots of other interesting things for both collegues and ambulance nurses
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